|
|
||||||||
Eur J Cardiothorac Surg 1999;15:631-638
© 1999 Elsevier Science NL
a Department of Pediatric Cardiac Surgery, The University of California, San Francisco, CA, USA
b Department of Pediatric Echocardiography, The University of California,San Francisco, CA, USA
Received 6 July 1998; received in revised form 26 January 1999; accepted 1 February 1999.
Corresponding author. Tel.: +1-415-476-3501; fax: +1-415-476-9678.
Objectives: Discrete subaortic stenosis causes left ventricular outflow tract (LVOT) obstruction and often produces aortic regurgitation (AR) which alone may precipitate surgical intervention. Conventional resection relieves the obstruction, but the recurrence rate is high, and the AR is little changed as the thick fibrous membrane which extends onto the valve leaflets remains. We studied whether an aggressive surgical approach could reduce both the severity of AR and rate of recurrence of obstruction associated with discrete subaortic stenosis, and whether this aggressive approach could be justified. Methods: Between June 1992 and April 1996, 37 patients aged 0.535 years (median 7.5) underwent resection of a discrete subaortic membrane. Ten underwent re-operation for recurrent obstruction and eight followed previous ventricular septal defect closure. LVOT gradient was measured using the modified Bernoulli equation and AR was graded on a scale of 04 (0=none, 4=severe). Postoperative assessment was performed early (<7 days) and at mid-term (27.0 months; range 259 months). Results: There was significant improvement in AR from mild/moderate to none/trivial (P=0.019) immediately postoperatively and LVOT gradient from 66.9±30.4 to 15.1±12.2 mmHg (P<0.0001). By stepwise logistic regression preoperative gradient correlated significantly with postoperative mild/moderate AR (P=0.015) and LVOT gradient (P=0.0036). Preoperative mild/moderate AR also correlated with postoperative mild/moderate AR (P=0.034). Five patients developed complete heart block, four undergoing reoperation for recurrent obstruction, and one preoperatively had right bundle branch block from previous ventricular septal defect repair. At mid-term follow-up there was no increase in AR or LVOT gradient (14.8±12.8 mmHg). Early post-operative AR was the strongest predictor of late mild/moderate AR (P=0.02). Early post-operative gradient was a weaker predictor (P=0.04). Pre-operative and early post-operative gradient were significant predictors of late gradient (P=0.0038; <0.0001, respectively). No patient required reoperation for recurrent obstruction; one underwent late aortic valve replacement for severe AR. Conclusions: An aggressive surgical approach to discrete subaortic stenosis produces excellent relief of obstruction and frees the valve leaflets, significantly reducing associated AR at early and mid-term follow-up with low morbidity for primary operation. Long-term follow-up is required to confirm whether this early benefit is maintained.
Key Words: Subaortic stenosis Aortic regurgitation Recurrent obstruction
This article has been cited by other articles:
![]() |
S. Talwar, S. K. Choudhary, and B. Airan Reoperation after relief of congenital subaortic stenosis Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 700 - 700. [Full Text] [PDF] |
||||
![]() |
A. Dodge-Khatami, M. Schmid, V. Rousson, M. Fasnacht, C. Doell, U. Bauersfeld, and R. Pretre Risk factors for reoperation after relief of congenital subaortic stenosis Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 885 - 889. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Geva, C. J. McMahon, K. Gauvreau, L. Mohammed, P. J. del Nido, and T. Geva Risk Factors for Reoperation After Repair of Discrete Subaortic Stenosis in Children J. Am. Coll. Cardiol., October 9, 2007; 50(15): 1498 - 1504. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. Karamlou, R. Gurofsky, A. Bojcevski, W. G. Williams, C. A. Caldarone, G. S. Van Arsdell, T. Paul, and B. W. McCrindle Prevalence and Associated Risk Factors for Intervention in 313 Children With Subaortic Stenosis Ann. Thorac. Surg., September 1, 2007; 84(3): 900 - 906. [Abstract] [Full Text] [PDF] |
||||
![]() |
V. Hraska, J. Photiadis, and C. Arenz Surgery for subvalvar aortic stenosis resection of discrete subvalvar aortic membrane MMCTS, July 23, 2007; 2007(0723): 2303. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. Barkhordarian, H. Uemura, M. L. Rigby, B. Sethia, D. Shore, A. Goebells, and S. Yen Ho A retrospective review in 50 patients with subaortic stenosis and intact ventricular septum: 5-year surgical experience Interactive CardioVascular and Thoracic Surgery, February 1, 2007; 6(1): 35 - 38. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Ruzmetov, P. Vijay, M. D. Rodefeld, M. W. Turrentine, and J. W. Brown Long-term results of surgical repair in patients with congenital subaortic stenosis Interactive CardioVascular and Thoracic Surgery, June 1, 2006; 5(3): 227 - 233. [Abstract] [Full Text] [PDF] |
||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |